VAERS ID: 2021590

AGE: 65| SEX: F|STATE: CA (United States)

Description

Two weeks after booster, experienced weakness, extreme fatigue and cognitive difficulties/brain fog. Passed out on 11/11 and taken by ambulance while non responsive, to hospital where I stayed 8 days. Transferred by ambulance to hospital where I remained for 11 days and was diagnosed with MIS-A. I was treated with antibiotics and steroids for organ involvement/infection. High fever, breathing difficulty, immobile due to weakness.

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Symptoms

Pyrexia, Dyspnoea, Infection, Asthenia, Fatigue, Laboratory test, Cognitive disorder, Loss of consciousness, Unresponsive to stimuli, Feeling abnormal, Mobility decreased, Multi-organ disorder, Multisystem inflammatory syndrome

Vaccines

VAX DATE: 10-07-2021| ONSET DATE: 10-27-2021| DAYS TO ONSET: 20
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH FE3590 IM RA

RECVDATE:01-10-2022
RPT_DATE:
CAGE_YR:65
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:19
X_STAY:U
DISABLE:Y
RECOVD:N
LAB_DATA:Various, please get from Dr.
V_ADMINBY:PHM
OTHER_MEDS:Nifedipine, synthroid, edarbi, bystolic, mybetrec, jardiance
CUR_ILL:none
HISTORY:occ asthma prediabetes
PRIOR_VAX:Pfizer second dose, 3 months of side effects March 2021
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-10-2022
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:levaquin, and all statins, sulfa, penicillin, gentamycin
V_FUNDBY:

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